Medications at the End of Life
Care at the Time of Death
Answer questions and review the signs and potential events that can be expected. For many families and caregivers, knowing ahead of time decreases anxiety. Most people do not know much about death
Signs of death discussed with family:
The heart stops beating; breathing stops; pupils become fixed; body color becomes pale and waxen as blood settles; body temperature drops; muscles and sphincters relax, urine and stool may be released; eyes may remain open; the jaw can fall open; the trickling of fluids internally may be heard
After expected death occurs:
Go to the bedside to comfort family members who are distressed and appreciate that the doctor shows “he or she cared.” This need not take more than 5–10 minutes
Participate with nursing to create a visually peaceful and accessible environment. A few moments spent alone in the room positioning the patient's body, disconnecting any lines and machinery, removing catheters, and cleaning up any mess will allow the family closer access to the patient's body. If eyes remain open, eyelids can be manually held closed for a few minutes and will usually remain closed once they dry. If they remain open, a small amount of surgical tape or a short Steri-Strip will hold them closed for longer without pulling on eyelashes when they are removed. If the jaw falls open as muscles relax, a rolled-up towel placed under the chin with the head elevated on pillows will usually hold the jaw closed until muscles stiffen some 4–6 hours later
The doctor may need to tell the “bad news” of a patient's death to someone who didn't have previous warning. Follow the guidelines for communicating bad news. Avoid breaking unexpected news by telephone, as communicating in person provides much greater opportunity for assessment and support. Tell them what to expect before they see the body (eg, changes in body color, temperature, and the scene they will see)
Writing a Condolence Note